Great Lakes Gastroenterology | Colon Cancer Screenings ...



-266700-32686500Keith Friedenberg, M.D.Don Brinberg, M.D.Sayed Khatami, M.D.Keyur Parikh, M.D.Dear Patient,In an effort to make sure you receive the highest level of coverage, please read and follow the instructions below:Prior to your scheduled procedure –When scheduling a colonoscopy as a routine screening procedure, contact your insurance to inquire if you have routine screening coverage. If you do not have routine screening coverage, notify our office prior to your procedure. Some Insurance companies require the CPT codes we will use for the billing of your procedure when you call.PROCEDURE CODE(s): 45378 -- Colonoscopy 45380 -- Colonoscopy with Biopsy 45385 – Colonoscopy with Polyp Removal 43239 – EGD with Biopsy 45331 – Flex Sig 46930 – IRC Destruction of Hemorrhoid DIAGNOSIS CODE(s): Z12.11 – Screening for colon cancer Ask your physician’s office for your diagnosis code – EGD/Flex Sig/IRCTAX ID NUMBERS: Great Lakes Gastroenterology, LLC. – 201466945 Mentor Anesthesia, LLC. – 450894082 The Endoscopy Center of Lake County, LLC. – 204005883If you had a colonoscopy in the past for a medical condition, such as, personal history of colon polyps (Z86.010) personal history of colon cancer (Z85.038) your current procedure may not be considered a routine screening/preventative procedure. Contact your insurance company to verify your coverage.If you are scheduled for a Screening Colonoscopy and during the course of the procedure the physician removes a colon polyp, takes a biopsy or diagnoses a medical condition your Colonoscopy may no longer be considered as a Screening Colonoscopy (This applies to all patients). Contact your insurance company to verify your coverage.You will receive a separate charge from Mentor Anesthesia, LLC. For your anesthesia services. Please contact our office with any questions. You will receive a separate charge for our facility. The facility name is “The Endoscopy Center of Lake County, LLC”. Call your insurance company to verify that our facility is in network with your plan. We will review eligibility, and benefits prior to your scheduled procedure. All known Copays, Coinsurance, and Deductibles are due at the time of service. You will receive a call from our billing department with the amount owed prior to your procedure.Due to the number of insurance companies and policies, we are unable to take responsibility for knowing your insurance benefits. You must contact your insurance company to question your plan and coverage. Our office will obtain a precertification if it is required, but this is not a guarantee of payment.If you have questions regarding this information, please contact our Billing Department at (440)-205-1225, Option 7.Patient Signature____________________________________________________ Date_______________________08/17 ................
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